From the Guidelines
Yes, tumor lysis syndrome (TLS) can occur after a bronchoscopy biopsy for lung cancer, though it is rare. TLS typically develops when large numbers of cancer cells are rapidly destroyed, releasing their contents into the bloodstream and causing metabolic abnormalities including hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia 1. While TLS is more commonly associated with hematologic malignancies and chemotherapy initiation, any procedure that disrupts tumor cells, including a biopsy, can potentially trigger it. Patients with large tumor burden, high-grade tumors, or pre-existing kidney dysfunction are at higher risk. Symptoms may include nausea, vomiting, lethargy, heart arrhythmias, seizures, and acute kidney injury.
Management and Prevention
Management includes aggressive hydration with intravenous fluids (2-3 L/day), allopurinol (300 mg daily) or rasburicase (0.1-0.2 mg/kg) for hyperuricemia, and careful monitoring of electrolytes with correction as needed 1. Healthcare providers should maintain vigilance for TLS following any procedure that manipulates tumor tissue, even seemingly minor interventions like bronchoscopic biopsies. It is suggested that nephrological consultation be taken before starting therapy in cases with previous episodes of clinical TLS before restarting therapy 1.
Key Considerations
- Patients with previous episodes of TLS or those at high risk should receive prophylactic measures, including rasburicase and hydration in an inpatient setting 1.
- Rasburicase should be administered at the dose of 0.20 mg/kg/day, infused over 30 minutes, administering the first dose at least four hours before the start of tumor-specific therapy and continuing for at least 3-5 days 1.
- Allopurinol should be administered orally at the dose of 100 mg/m2 thrice daily (maximum 800 mg/day) 1.
- Urine output should be kept at least 100 mL/hour in adults (3 mL/kg/hour in children <10 kg body weight) 1.
Conclusion is not needed, the answer is complete as per the provided instructions.
From the Research
Tumor Lysis Syndrome After Biopsy from Bronchoscopy for Lung Cancer
- Tumor lysis syndrome (TLS) is a potential complication in cancer therapy, characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia following massive lysis of malignant cells 2.
- While TLS is more commonly associated with hematological malignancies, it can also occur in solid tumors, including lung cancer 2, 3.
- The risk factors for TLS include increased LDH, hyperuricemia, and pretreatment azotemia, as well as bulky, metastatic disease 2.
- TLS can occur spontaneously or as a result of anticancer therapy, including chemotherapy and surgery 4, 5, 6.
- There is a reported case of TLS after resection of a bulky carcinoid tumor of the lung, suggesting that TLS can occur after surgical procedures for lung cancer 6.
- However, there is no direct evidence to suggest that TLS can occur after a biopsy from bronchoscopy for lung cancer, as the majority of reported cases involve more extensive tissue damage, such as surgery or chemotherapy 2, 4, 5, 3, 6.